What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches.

OBJECTIVE: We aimed to investigate the efficacy and safety of five different treatment approaches in patients with a great saphenous vein (GSV) diameter of ≥10 mm. METHODS: A total of 697 extremities of 671 patients who were diagnosed with a GSV diameter of ≥10 mm underwent conventional surgery or endovenous therapy for symptomatic varicose veins between January 2012 and January 2017 were included in this retrospective study. All extremities included in the study were divided into five groups as follows: high ligation + stripping (HLS), radiofrequency ablation (RFA), cyanoacrylate closure (CAC), endovenous laser ablation (EVLA) procedures at 980 nm and 1,470 nm wavelengths. RESULTS: Among all groups, despite lower recurrence rates in HLS group than the other groups, there was no significant difference at 6 months and 1 year among the HLS, EVLA at 1,470 nm wavelength, and RFA groups. The recurrence rates of EVLA at 980 nm wavelength and CAC groups were found higher than other groups. CONCLUSIONS: In conclusion, our study results show that although HLS seems to be an effective method for the treatment of a GSV diameter of ≥10 mm with a low recurrence rate, it does not statistically significantly differ from EVLA at 1,470 nm wavelength and RFA. Therefore, we believe that EVLA at 1,470 nm wavelength and RFA can be preferred over HLS with low pain scores in this patient population.

Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers.

BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.

Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers

ABSTRACT BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.

Acetaminophen Mitigates Myocardial Injury Induced by Lower Extremity Ischemia-Reperfusion in Rat Model.

OBJECTIVE: The injury-reducing effect of acetaminophen, an effective analgesic and antipyretic on ischemia-reperfusion continues to attract great attention. This study analyzed the protective effect of acetaminophen on myocardial injury induced by ischemia-reperfusion in an experimental animal model from lower extremity ischemia-reperfusion. METHODS: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage. RESULTS: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124). CONCLUSION: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion.

Acetaminophen mitigates myocardial injury induced by lower extremity ischemia-reperfusion in rat model

Abstract Objective: The injury-reducing effect of acetaminophen, an effective analgesic and antipyretic on ischemia-reperfusion continues to attract great attention. This study analyzed the protective effect of acetaminophen on myocardial injury induced by ischemia-reperfusion in an experimental animal model from lower extremity ischemia-reperfusion. Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage. Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124). Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion.

A rare complication after axillofemoral bypass operation: disruption of the proximal anastomosis: single case after 12 years' experience in extra-anatomic bypass surgery.

Axillofemoral bypass operation is an alternative approach for patients at high risk for aortofemoral reconstruction and for patients with comorbid factors. Proximal anastomotic disruption, upper extremity thromboembolism, graft infection and seroma formation are known postoperative complications after axillofemoral bypass. Proximal anastomotic disruption is a severe complication in the early postoperative period and is usually secondary to technical errors in anastomosis, mechanical distress and infections. We performed a left axillofemoral bypass and left femoropopliteal bypass operation under general anesthesia by using an 8 mm full ringed polytetrafluoroethylene graft. On the seventh postoperative day, patient complained a sudden pain and swelling on left subclavian incision after a hyperabduction of the left arm. Patient was taken into operation theatre just after this complaint for suspicion of disruption of the proximal anastomosis. We report a case with proximal anastomotic disruption after axillofemoral bypass operation in accordance with literature data.